Ailing system struggles with inmate care

Maryland seeks improvement as prisons get new providers.

A Sun Special Report

In mid-March 2002, Marcella N. Leski, 39, was jailed for failing to appear in court on a drug-possession charge. Twelve days later, she was so ill that her legs were amputated below the knees.

Her family alleges in a lawsuit that the prison contractor's doctor failed to diagnose and treat an infection that can be cured with antibiotics.

While the question of legal responsibility is in dispute, what is not in question is that Leski's condition deteriorated while she was in the custody of the state-run Baltimore Women's Detention Center.

Maryland's prisons are no place to get sick. The state's own audits and correctional system records show that the prison health care system has been underfunded, understaffed and poorly run.

A Sun investigation found that many inmates over the past five years have received inadequate medical attention, according to interviews, independent state audits, internal state records and other documents.

"We believe [health care] was constitutionally adequate," said Richard Rosenblatt, who oversees medical care for the Department of Public Safety and Correctional Services. "But it was not the type of health care we felt we should be delivering."

Prison Health executives say they provided appropriate care to inmates, including Leski, despite rapidly escalating health care costs and a contract the company signed in 2000 that turned out to be a money-loser.

As of June 30, Prison Health, one of the nation's largest for-profit correctional health care providers, will no longer be providing inmate health services in Maryland. Its contract expires on that date, and the state recently selected other vendors to provide services for the state's 27,000 inmates in a totally restructured system.

Over the next fiscal year, the state expects to pay roughly 60 percent more for inmate health care services - or $110 million compared with $68 million spent last year.

But some prisoner advocates say they doubt that the situation will improve despite the additional money and change in contractors. They say profit motives will continue to influence the quality of care that prisoners receive.

While Rosenblatt acknowledges that there have been problems, he says he is confident that the introduction of the revamped and better-funded system, using the new vendors, on July 1, will solve them.

Prison Health executives say they pleaded to get out of the contract two years ago but the state refused, and that Maryland continued to pay far less for services than it was costing Prison Health to deliver. The company says it was paid more than $260 million in Maryland over the past five years, but lost $14 million.

"What you can say is that, in retrospect, it was a bad business decision," said Richard D. Wright, who until March 31 was Prison Health's president and chief executive. He is now a consultant to the company and was designated to speak about its dealings with Maryland.

A grim picture

State audits, lawsuits, internal memos and other documents reveal a grim picture of inmate heath care since 2000, when Prison Health got its contract.

The problems include:

Insufficient staffing. Staff shortages have caused lengthy delays in prisoners being seen by physicians, psychiatrists and nurses, according to audits of prison infirmaries done by the state Office of Health Care Quality, an independent state agency that monitors health care facilities in Maryland.

Baltimore's jails, the Central Booking and Intake Center and the city detention center, could provide psychiatrists for only 100 of the 156 hours required each week last year, according to a Sun review of staffing records. During this period, the facilities had five inmate suicides - the highest in seven years, records show. The previous year there were two.

Poor medical record-keeping that interfered with the delivery of care. State auditors found several examples of the problem at different prisons.

On a March 2002 visit to the infirmary at the Maryland House of Correction in Jessup "it was observed that one inmate had been in a bed on the unit for more than 15 hours," auditors from the state health care quality office wrote. "There was no admission order, transfer note, vital signs, history, initial nursing assessment, documentation of nursing protocols or any treatment/care plan. Interviews with the nursing staff on the unit revealed that there was no information on the inmate."

And records that are kept are not always reliable. For example, state corrections officials discovered in March that Prison Health staff members apparently had altered records to falsely indicate that they had conducted required checks on suicidal inmates every 15 minutes at the Women's Detention Center in Baltimore, according to e-mail between state and Prison Health officials. The employees involved resigned, Prison Health executives said.